tbuckley/cabot-search huggingface dataset:
Establishing the feasibility of a patient-engagement tool to improve outpatient symptom management and dosing of patients on regorafenib.
Authors: Reetu Mukherji, Amani Boudriga, Howard Isenstein, John Marshall
Journal: Journal of Clinical Oncology (2022)

417 Background: Regorafenib (rego), an oral multikinase inhibitor, improves overall survival in patients (pts) with metastatic colorectal cancer (mCRC). However, its toxicity profile including, but not limited to, hand-foot skin reactions, fatigue, and hypertension significantly limits its use and often requires dose interruptions (40% rate) or modifications (20-25% rate). Inadequate symptom management can lead to frequent clinic visits, reduced quality of life, therapy non-adherence, and poor clinical outcomes. We aimed to establish the feasibility and usability of a CarePrompter smartphone application (app), a digital pt engagement tool with a pt and provider interface, to monitor and triage pt symptoms when starting rego. Methods: mCRC pts starting rego for the first time and with access to an iOS or Android smartphone with a data plan were recruited at MGUH. Pts were enrolled for the duration of their rego treatment. Once consented, recruiters downloaded and registered pts on the mobile app. Pts were provided a blood pressure (BP) cuff and trained on how to record their BP and answer a customized set of up to 17 questions daily on the app. The questions included documenting the status of the daily dose taken, completion of weekly labs, BP, whether pts needed advice, and severity of various side-effects if present on a 1-10 scale. Oncologists and nurses trained to use a CarePrompter triage tool were alerted when pts indicated missed doses, missed labs, high blood-pressure, high side-effect scores (8-10), and request for advice. Results: A total of 11 pts enrolled in the study. The study duration ranged from 1 to 5 months per pt. Pts, on average, completed the app questionnaire 10 out of 30 days, with the lowest rate of completion being 2 out of 30 days and the highest rate being 20 out of 30 days. BP recordings were logged an average of 10 times per pt in a 30-day period. An average of 2 provider alerts were triggered per pt. The alerts were primarily from pts documenting not performing labs or omitting rego doses. All alerts were acknowledged and resolved by a provider through the CarePrompter-triage tool. Providers found the tool usable based on qualitative interviews. There was an average dose increase of 1.25 rego pills from pt’s start to end dose. While 62.5% of pts were treated with the highest dose (160 mg) at one point in their treatment, by the end of the study 25%, 50%, and 25% remained on 160 mg, 120 mg, and 80 mg doses, respectively. Conclusions: The CarePrompter mobile app was technically feasible and usable by cancer patients and providers in monitoring symptoms and addressing real-time ambulatory issues during rego dosing. Additional studies are warranted to determine if routine utilization of this app in clinic translates to enhanced patient experiences, toxicity management, daily dosing, therapeutic compliance, and survival.
Increasing advance directive completion within the 4R oncology model in patients with breast cancer prior to surgery in a racially diverse patient population.
Authors: Stephanie Ossowski, Liisa Lyon, Elizabeth Shurell Linehan, Nancy P. Gordon, Olga Egorova, Becky Mark, Kimberly Beringer, Thea Abbe, Aida Shirazi, Christine B. Weldon, Julia R. Trosman, Arliene Ravelo, Raymond Liu
Journal: Journal of Clinical Oncology (2022)

54 Background: Advance directives (ADs) are an important part of life care planning in patients with cancer. There is a lack of effective interventions to increase AD rates in breast cancer patients prior to surgery. In this quality improvement project, we implemented an intervention for breast cancer patients receiving care in an integrated healthcare delivery system. 4R (Right Info / Right Care / Right Patient / Right Time) is a novel care planning and delivery model that enables the patient and oncology care team to manage complex time-sensitive care using a multi-modality 4R Care Sequence plan, coupled with follow-up workflows. Methods: We studied two groups of patients with newly diagnosed non-metastatic breast cancer who attended a multidisciplinary clinic and underwent definitive surgery at one facility. The Usual Care (UC) cohort received care from 10/1/19 to 9/30/20. The 4R Intervention (4R) cohort received care from 10/1/20 to 9/30/21 using a 4R Care Sequence plan that included AD completion prior to surgery; those without an AD were referred for follow-up to a health educator to discuss AD completion. Bivariate analyses were used to compare the UC and 4R cohorts on demographics, NCCN thermometer distress scores, and AD completion rates. Results: Characteristics of age, gender, race/ethnicity, needing interpreter, Elixhauser Comorbidity Index, NCCN distress scores &gt; 4, surgery type, grade, ER/PR/HER-2 status were similar in the UC (N = 140) and 4R cohorts (N = 141). AD completion prior to surgery was significantly higher for the 4R vs. UC cohort, both overall (15% vs 74%, p &lt;.01), and for White, Black, and Asian/PI subgroups (Table). The Hispanic subgroups were too small to compare AD completion. AD completion did not significantly differ by higher vs. lower distress scores. Conclusions: Implementation of a 4R Care Sequence plan coupled with health educator follow-up can significantly increase rates of time-sensitive AD completion, regardless of patient distress score and patient race/ethnicity. Use of an effective standardized care delivery model like 4R can promote equitable care.[Table: see text]
Surviving colorectal cancer: A study of information needs and health-related quality of life.
Authors: Lynette Hammond Gerido, Paul Abrahamse, Rachel Tocco, Thomas Braun, Sarah T. Hawley, Christine M Veenstra
Journal: Journal of Clinical Oncology (2022)

223 Background: Colorectal cancer (CRC) is a life changing process, which impacts survivors’ health-related quality of life (HRQoL). CRC survivors face new uncertainties and have specific information needs. While advances in CRC treatment have increased the number of survivors, little is known about how information needs differ across groups of survivors, or whether information deficits influence HRQoL. Methods: In 2019-2020 we surveyed patients who, in 2014-18, underwent resection of Stage III colorectal cancer and were seen at a community oncology practice, an academic cancer center, or reported to Georgia SEER (51% RR). Patients were asked questions about survivorship, including their need for additional information (NAI) about CRC follow-up care. HRQoL was measured using PROMIS—29+2 Profile v2.1. Patients also self-reported their race and their belief about whether they were cancer free. Associations between patients’ NAI and covariates (including race and belief in being cancer free) were assessed with logistic regression, while associations between HRQoL scores and covariates were assessed with one-way analysis of variance (ANOVA). We used linear regression to assess relationships between NAI and HRQoL. Results: Data from 380 patients were included in these analyses. 44% were &gt; age 65, 84% white, 22% had &lt; high school education, and 32% had a household income of less than $60,000. 55% indicated a need for more information about CRC follow-up care. 90% believed that they were currently cancer free. Black CRC survivors were significantly more likely to report an information need compared to White patients (OR 2.446, 95% CI 1.147-5.217; p = 0.02). Patients who believed they were currently cancer-free were significantly less likely to report an information need compared to patients who did not believe they were cancer-free (OR 0.357, 95% CI 0.169-0.750; p &lt; 0.01). Having a need for additional information was significantly associated with worse HRQoL (difference in mean HRQoL score -0.26, standard error 0.19; p &lt; 0.01). Conclusions: Black CRC survivors were 2.4 times more likely to have an information need than White survivors. Survivors who believed they were currently cancer-free were 35% less likely to have an information need than those who did not share the same belief. Having an information need was associated with worse HRQoL. Tailored survivorship communications and patient education related to managing recurrence risk may help improve HRQoL among CRC survivors.
Improving cardiac monitoring in patients with early-stage breast cancer receiving cardiotoxic chemotherapy in a multidisciplinary cancer center.
Authors: Hannah DeLuna, Dmitriy Velikov, Hardik Patel, Jamie Feld, Jason Robin, Carol A. Rosenberg, Poornima Saha
Journal: Journal of Clinical Oncology (2022)

191 Background: Patients with early stage breast cancer commonly receive anthracycline and anti-Her2 directed therapies which can result in cardiotoxicity, making cardiac monitoring crucial. In 2018, our rate of obtaining a follow up echocardiogram in this patient population was 38%. Subsequently, use of myocardial strain imaging in conjunction with echocardiography became available at our institution, allowing for potential earlier detection of cardiac dysfunction. We aimed to increase utilization of strain imaging and rate of follow up echocardiogram monitoring to at least 50% in hopes of enhancing prevention efforts. Methods: We developed a standardized protocol for cardiac monitoring in patients receiving cardiotoxic chemotherapy. We provided education to staff and workflow modification to include standard orders for strain echocardiogram in all relevant chemotherapy plans. Chart review for Stage 1-3 breast cancer patients who received anthracycline or trastuzumab based therapy at our ambulatory cancer center from January 2019 to December 2021 was performed. Completion of follow up echocardiogram and rate of strain imaging before and after July 2020 was assessed, as this is when strain imaging became widely available. Results: Rates of obtaining baseline echocardiogram were excellent. Rates of strain echocardiogram use improved from 26.3% to 97.9% following July 2020. Follow up echocardiograms were obtained regularly in those receiving trastuzumab based therapy before and after July 2020 at rates of 91.8% and 87.5%. Rates of follow up echocardiograms in those receiving anthracycline-based therapy also improved to our goal of greater than 50%, but was lower than the trastuzumab group at 57%. However, assessment of follow up cardiac imaging in the 2021 treatment group is still ongoing. Conclusions: We successfully implemented a program to standardize cardiac monitoring in patients undergoing cardiotoxic chemotherapy for breast cancer at our institution. We anticipate this will enhance detection of cardiotoxicity and utilization of consultative cardio-oncology services. Additional efforts to improve follow up cardiac imaging through collaboration with our survivorship program are ongoing.[Table: see text]
Race in a molecular tumor board compared to cancer registry population.
Authors: Jamie Randall, Hongkun Wang, Timothy Lewis Cannon, Arthur Winer, Raymond Couric Wadlow
Journal: Journal of Clinical Oncology (2022)

103 Background: Disparities in cancer care due to race and ethnicity are prevalent in both the care patients receive and patient outcomes. The evaluation of next generation sequencing (NGS) results from patients with advanced cancer by a molecular tumor board (MTB) has become standard practice in many institutions for the identification of additional treatment options and targeted therapies. We sought to compare the racial distribution of patients evaluated by our MTB with our institutional cancer registry (CR). Methods: We tabulated the racial distribution of 560 MTB patients chosen for presentation in a bimonthly case conference based on physician request or clinical interest from more than 2,500 NGS reports of patients with advanced cancer from 2016 through 2020. Self-identified race from patients with stage 4 cancer within our institutional CR from the same time interval was compared to the MTB population from each year using the Chi-Squared test. The Cochran-Mantel-Haenszel test was used to analyze the relationship between race and MTB/CR after controlling for year. Race categories were defined as Asian, Black/African-American (AA), White/Caucasian, and other. Results: We identified 4,151 CR patients with stage 4 cancer from 2016 through 2020, 573 of whom identified as Black/AA (13.8%). Of the 560 MTB patients, 55 were Black/AA (9.8%). When controlling for year, Black/AA patients were less frequently included in the MTB compared to the CR (p = 0.0128). Conclusions: Black/AA patients with advanced cancer are under-represented in our MTB. Larger studies are warranted to examine underlying causes of this discrepancy including implicit bias, generalizability of this finding to other minorities and institutions, and potential remedies to ensure equitable access to state-of-the-art cancer care.[Table: see text]
Therapeutic interchange: The cornerstone of cost effectiveness in the Oncology Care Model performance for the U.S. Oncology Network.
Authors: Hope Ives, Erica Feinberg, Puneeth Indurlal, Lalan S. Wilfong, Kaci Dominguez, Jody S. Garey
Journal: Journal of Clinical Oncology (2022)

5 Background: The Oncology Care Model (OCM) is a Medicare value-based care program, that rewards practices for decreasing the total cost of care (TCOC) compared to a benchmark price. Enrolled patients are evaluated in 6-month episodes within a 1-year time window called Performance Periods (PP). The use of lower cost medication alternatives (LCA) is a critical strategy to bend the cost curve. Therapeutic interchange (TIC) with lower-cost generic/biosimilar/therapeutic alternative medications offer significant cost savings to payers and patients while maintaining equivalent quality of care. LCA for eight high-cost oncology therapeutic or supportive care medications became available during or just prior to OCM. The results of a clinically appropriate, physician-supported, pharmacist-led interchange of high-cost medications to LCA in The US Oncology Network (The Network) during OCM PP 7 (PP7), 8 (PP8), and 9 (PP9) is described here. Methods: Medicare Part B &amp; D claims for 14 OCM practices in The Network were used to evaluate the impact of eight TIC opportunities during PP 7-9. TIC opportunities included changing therapy from reference products to biosimilars (bevacizumab, trastuzumab, rituximab, pegfilgrastim and filgrastim), from brand to generics (abiraterone, imatinib, fosaprepitant) and from high cost to LCA (aprepitant to fosaprepitant, denosumab to zoledronic acid). TCOC impact was measured by comparing the cost of each dose of the LCA vs the estimated cost if the more expensive alternative had been used instead. Results: The shift from high cost to LCAs in PP7, PP8 and PP9 is shown in Table as percentage of total doses dispensed or administered. Transitions from aprepitant to fosaprepitant, and from denosumab to zoledronic acid was done when clinically appropriate (as determined by the treating physician). The cumulative savings from TIC was $26.0M in PP7, $32.3M in PP8 and $32.9M in PP9. TIC to biosimilars contributed $6.6M in PP8 and $12.2M in PP9 of the cumulative savings. TIC reduced TCOC by 2.78% in PP7, 4.13% in PP8, 5.25% in PP9 within the OCM. Conclusions: TIC to biosimilars, generics and clinically appropriate LCA is an effective way to reduce TCOC while maintaining quality care in the OCM. Even small shifts in utilization towards LCA can generate a significant reduction in TCOC. Physician-supported, pharmacist-led TIC initiatives are critical to bending the cost curve within Oncology.[Table: see text]
“It’s just not easy to understand”: Health insurance literacy and insurance plan decision-making among cancer survivors.
Authors: Courtney Williams, Amy J. Davidoff, Janet De Moor, Robin C. Vanderpool, Heather Platter
Journal: Journal of Clinical Oncology (2022)

16 Background: Little is known about how cancer survivors choose health insurance plans and whether low health insurance literacy (HIL) may lead to inadequate coverage or high out-of-pocket (OOP) costs. Methods: This prospective, explanatory mixed methods study assessed health insurance decision-making in a sample of adult cancer survivors &lt; 5 years from diagnosis. Quantitative eye-tracking data were collected from two simulated health insurance plan choice sets to gauge interest in plan benefits (measured by dwell time, or seconds of no eye movement; longer dwell time indicates more interest). Ranking of the most important and confusing plan benefit, HIL (HIL Measure; scored 20-84, higher scores indicate higher HIL), and sociodemographic data were also captured. Differences in benefit-specific dwell time by HIL were estimated using adjusted linear models. Qualitative, semi-structured interviews clarified a subset of survivors’ health insurance plan decision-making. Content analysis identified emergent patterns and themes. Results: With a median HIL score of 60 (IQR 50-70), survivors (N = 80) were 65% female, 59% non-Hispanic White, and a median age of 43 at diagnosis (IQR 34-52). Breast cancer diagnoses were most common (38%) and most survivors had received surgery (75%), radiation (55%), or systemic therapy (75%). In the choice set comparing a traditional and high-deductible health plan, survivors were most interested in prescription drug costs (median dwell time 58s, IQR 34-109), but no differences in interest were found comparing survivors with high and low HIL in adjusted models. In the choice set comparing a health maintenance organization and preferred provider organization plan, survivors were most interested in test and imaging costs (40s, IQR 14-67), with survivors with low vs. high HIL having more interest in deductible (β = 19s, 95% CI 2-38) and hospitalization costs (β = 14s, 95% CI 1-27) in adjusted models. Survivors with low vs. high HIL more often ranked low OOP maximums as the most important benefit (53% vs. 38%) and coinsurance as most confusing (68% vs. 53%). Interviews (n = 20) revealed survivors felt alone “ to do their own research” about insurance choices. OOP maximums were cited as the deciding factor since it’s “how much money is going to be taken out of my pocket.” Coinsurance was referred to “rather than a benefit, it's a hindrance.” Opinions about specialist gatekeeping were mixed; some survivors valued the accompanying lower OOP costs, while others worried about care delays. Survivors also reported issues with coverage and cost transparency post-insurance decision. Conclusions: Benefit considerations in health insurance decisions are varied and confusing for cancer survivors with both high and low HIL. Interventions to aid in health insurance understanding and choice are needed to optimize plan choice and prevent cancer-related financial hardship.
Postoperative symptom monitoring with ePROs in an academic public hospital.
Authors: Gita N Mody, Jillian C Thompson, Brittney M Williams, Sachita Shrestha, Mary-Catherine Bryant, Annie Bright, Julia Nevison, Chase Cox, Miriam Perez, Bernice Newsome, Lauren Hill, Allison Mary Deal, Mattias Jonsson, Jason M Long, Benjamin E. Haithcock, Angela M. Stover, Antonia Vickery Bennett, Ethan Basch
Journal: Journal of Clinical Oncology (2022)

264 Background: Postoperative symptom burden is high in surgical oncology patients. Electronic patient-reported outcome (ePRO) remote monitoring systems are rapidly proliferating and have the promise of improving care. However, implementation in diverse practice settings is understudied. More information on ePRO participation may determine addressable barriers. Methods: Patients presenting to the Multidisciplinary Thoracic Oncology Program for surgery were prospectively enrolled. ePROs assessing common postop symptoms and functional impairments were administered via a web-based platform daily for 14 days and then weekly until 3 months post-discharge. Automated reminders were provided by email. Phone calls were made for 2 consecutive missed ePROs. ePRO participation levels were categorized as high (&gt; 80%), medium (50-80%), low (1-49%), and none. Patient characteristics were examined by participation level via Fisher’s exact and Kruskal-Wallis tests. Results: From 2020-2022, 202 patients were recruited to participate, and 113 (56%) agreed. There were no differences in demographics of agreed vs. declined. 99 patients initiated ePROs after discharge. Mean age was 60.5 years (sd 13.4), 37.8% were male, 72.5% were White, and the majority (64%) had lung resection. Patients participated in ePROs for an average of 82 days (sd 24) before discontinuing. Overall, 57.7% (1383/2397) of delivered surveys were completed; response rates were lowest in week 1 (48%) and highest in week 7 (71%). Participation levels are described in Table. Married/partnered patients were significantly more likely to have high levels of participation (p = 0.003), and those who regularly used a computing device almost reached significance (p = 0.057). Age, gender, race, employment, email/internet use, financial status, and quality of life did not vary across ePRO participation levels. Conclusions: Monitoring symptoms with ePROs after discharge from thoracic surgery is feasible in a large academic public hospital. Participation levels in ePROs are lower immediately after discharge, when symptomatic complications drive the highest rates of readmissions. This suggests an opportunity to improve ePRO implementation during the post-acute period when intensive monitoring is desired and in patients who are not partnered or are less frequent device users. As length of stay and readmissions are increasingly targeted for expenditure reduction in academic inpatient settings, it is paramount to design and implement systems to effectively monitor at-risk patients. Clinical trial information: NCT04342260. [Table: see text]
Clinical trial participation in a majority-minority, NCI-designated cancer center.
Authors: Ryan Bailey, Marcela Mazo- Canola, Heidi Chwan Ko, Adolfo Enrique Diaz Duque
Journal: Journal of Clinical Oncology (2022)

86 Background: Substantial racial and ethnic disparities exist in clinical trial enrollment. Because oncology has rapidly evolved into a field rife with therapies aimed at specific biologic differences in patients, disparities in the standard of care and treatment outcomes have arisen, mainly in minorities such as Hispanics, African Americans, and Native Americans/Alaskan Natives. These disparities are due mainly to the limited understanding of tumor biology in underrepresented groups. The lack of representation in clinical trial enrollment represents both a grave oversight in oncology and an opportunity to increase treatment options for underserved groups significantly. Methods: Retrospective single-institution analysis including patients enrolled in clinical trials between 2014 and 2018. We use a Negative Binomial generalized linear model to measure the racial and ethnic disparities in Mays Cancer Center's clinical trials accruals from 2014 to 2018. Results: 4724 patients with various tumor types were enrolled in clinical trials at the mays cancer center: Using a Negative Binomial generalized linear model, we discover that clinical trial enrollment is distinct in Blacks (e coefficient = 0.22, p = 1.38e-09) and Asians (e coefficient = 0.08, p = 3.03e-20) when compared to Whites. Hispanics and Non-Hispanics do not differ in clinical trial enrollments (e coefficient = 0.77, p = 1.34e-01). Both Hispanic and Non-Hispanic Asians are greatly underrepresented; Non-Hispanic whites are overrepresented. Hispanics of all races are overrepresented in breast cancer trials as compared with Non-Hispanics (p = 6.89e-18). The inverse is true for genitourinary trials, with Non-Hispanics being overrepresented as compared to Hispanics (p = 9.78e-46). Conclusions: Hispanics were disproportionately enrolled in breast cancer trials, and Non-Hispanics were disproportionately enrolled in GU trials. Mays Cancer Center outperforms similar institutions in the enrollment of Hispanics, yet despite this, Hispanics are still somewhat underrepresented in our trials. Asians broadly are underrepresented in MCC enrollments.